Using typical endoscopic features to diagnose esophageal squamous papilloma

Area of Science:

• Gastroenterology
• Pathology
• Endoscopic Imaging

Background:

• Superficial tiny lesions in the esophagus can be challenging to diagnose, sometimes leading to misclassification of squamous papilloma of the esophagus (SPE).
• Accurate endoscopic differentiation of SPE from other benign esophageal lesions is crucial for appropriate patient management.

Purpose of the Study:

• To identify and evaluate key endoscopic features that differentiate squamous papilloma of the esophagus (SPE) from other superficial esophageal lesions.
• To assess the diagnostic value of specific endoscopic appearances, including those visualized with narrow band imaging (NBI), for SPE.

Main Methods:

• Retrospective analysis of consecutive patients with esophageal polypoid lesions undergoing endoscopy.
• Evaluation of endoscopic images for specific characteristics: whitish color, exophytic growth, wart-like shape, and surface vessels under NBI.
• Pathological examination of biopsy specimens for definitive diagnosis and comparison with endoscopic findings.

Main Results:

• Out of 41 identified lesions, 24 were confirmed as SPE; others included squamous hyperplasia and glycogenic acanthosis.
• Exophytic growth, wart-like shape, and crossing surface vessels under NBI were significantly more common in SPE (P < 0.001).
• Wart-like projections (81.3% sensitivity) and exophytic growth (87.5% specificity) were key indicators, with high positive predictive values for these features.

Conclusions:

• A combination of exophytic growth, wart-like shape, and surface vessel crossing under NBI (diagnostic triad) demonstrates a high positive predictive value (88.2%) for diagnosing SPE.
• This diagnostic triad is a valuable tool for improving the accuracy of endoscopic diagnosis of squamous papilloma of the esophagus.